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Background Chronic thromboembolic pulmonary hypertension (CTEPH) is a form of pulmonary embolism, and pulmonary endarterectomy (PEA) is the surgical treatment. Asymmetric dimethylarginine (ADMA) levels are increased in pulmonary hypertension. This study aimed to investigate serum ADMA levels in patients with CTEPH, the effect of PEA on ADMA, and its prognostic value in long-term mortality. Method Eighty (80) patients with CTEPH and 32 healthy controls were included. Preoperative serum ADMA levels, determined using an enzyme-linked immunosorbent assay, were compared between patients with CTEPH and controls. Of 80 patients, 64 had PEA. Pre- and 6-month postoperative serum ADMA levels, 6-minute walk distance (6MWD), and haemodynamic parameters were collected from patients undergoing PEA. Patients were followed-up for survival analysis. Results Mean ± standard deviation serum ADMA levels were significantly higher in patients with CTEPH compared with controls (0.79±0.32 μmol/L vs 0.52±0.12 μmol/L; p=0.0001). Statistically significant differences were observed between preoperative and postoperative serum ADMA levels (0.78±0.30 μmol/L vs 0.62±0.22 μmol/L; p=0.0001), 6MWD (p=0.0001), and pulmonary vascular resistance (p=0.0001) in 60 patients who underwent and survived PEA. The decrease in serum ADMA levels and increase in 6MWD were significantly correlated (r=–0.286, p=0.027). No other correlation was found. Perioperative mortality was 6.3%, and the survival rate with a mean follow-up of 34.57±8.20 months was 93.3%. Patients with serum ADMA levels >0.8 μmol/L had a significantly lower survival rate (logrank: 5.86; p=0.015). Conclusions Levels of circulating ADMA might add diagnostic and prognostic information in CTEPH. Pulmonary endarterectomy is associated with an improvement in serum ADMA levels. Preoperative serum ADMA levels may be useful for estimating the outcome of PEA.

Background: Coronary calcium shows the atherosclerosis burden in coronary arteries and is associated with adverse cardiac events. Agatston score is the most widely used scoring sys-tem to quantify coronary artery calcium. In this study, we aimed to establish the factors associated with the change in Agatston score in time. Materials and Methods: Patients who underwent multiple coronary computerized tomo-graphic angiographies and had Agatston score measurements were included in the study. The change of Agatston score was compared among cardiovascular risk groups. Linear regres-sion model was formed to detect independent variables affecting the change in Agatston score.Results: A total of 126 patients were included in the study. 63 patients had zero baseline Agatston score. Patients with hypertension, diabetes or previous coronary artery disease history had significantly higher Agatston score changes than those without. Age and previous coronary artery disease increased the risk of Agatston score increase over time whereas zero baseline Agatston score decreased the risk.Conclusions: Age and previous coronary artery disease history are independent risk factors for the increase in Agatston score over time. Baseline Agatston score of zero decreases the risk of subsequent increase in Agatston score.

ObjectiveSince many studies focused on the relationshipbetween mean platelet volume (MPV) and severity oftype 2 diabetes mellitus (T2DM) or investigated MPVand coronary artery disease (CAD) mostly on acutecoronary syndrome (ACS), this study primarily focusedto investigate if MPV values have any relation withdifferent levels of CAD specifically in T2DM patients,who had no previous coronary artery disease, and noACS history.Materials And MethodsT2DM patients who had first coronary angiography(CAG) between November 2019 and February2020, and whose after night fasting blood testswere performed before CAG were included. Twocardiologists, blinded to the patients, evaluatedangiographies. Patients have divided into groupsaccordingly; normal coronary artery (Group 1),non-critic stenosis (Group II), and severe CAD(Group III) according to the Gensini score. Patients’demographics, heart rate, risk factors of CAD, andblood test including MPV were also collected.ResultsA total of 180 patients (88 female, 92 male) wereinvolved in the study. There was no significant relationbetween MPV and the severity of CAD in T2DMpatients (p=0.228). The mean age of the Group I groupwas significantly lower than in other groups (p=0.228),and there were significantly lower males in Group Ithan other groups (p=0.0001). The triglycerides levelswere significantly low in Group I than in other groups(p=0.021 and p=0.006).ConclusionMPV values were not associated with the severityof CAD in stable patients. Older age, male gender,higher levels of triglycerides, and initial glucose levelswere significantly related to the severity of CAD inT2DM patients., AmaçBirçok çalışma, ortalama trombosit hacmi (MPV) iletip 2 diabetes mellitus (T2DM) şiddeti arasındaki ilişkiyeodaklanmakta veya MPV ve koroner arter hastalığı(KAH) çoğunlukla akut koroner sendrom (AKS)hastaları üzerinde gerçekleştirilmektedir. Bu çalışmaöncelikle koroner arter hastalığı ve AKS öyküsü olmayanT2DM hastalarında MPV değerlerinin farklı derecelerdekiKAH ile ilişkisi araştırılmıştır.Gereç ve YöntemKasım 2019 ile Şubat 2020 tarihleri arasında ilk koroneranjiyografi (CAG) yaptıran ve CAG öncesi geceaçlık kan testleri yapılan T2DM hastaları dahil edildi.Anjiyografiler iki kardiyolog değerlendirdi. Hastalar bubulgular ve Gensini skoruna göre; normal koroner arter(Grup 1), kritik olmayan darlık (Grup II) ve ciddiKAH (Grup III) olarak 3 gruba ayrıldı. Hastaların demografikverileri, kalp atış hızı, CAD risk faktörleri veMPV dahil kan testleri değerlendirildi.BulgularÇalışmaya toplam 180 hasta (88 kadın, 92 erkek)dahil edildi. T2DM hastalarında MPV ile KAH şiddetiarasında anlamlı bir ilişki bulunmadı (p=0,228).Grup I grubunun ortalama yaşı diğer gruplardan anlamlıolarak daha düşüktü (p=0,228). Grup I'de diğergruplara göre anlamlı oranda düşük sayıda erkekvardı (p=0,0001). Trigliserid düzeyleri Grup I'de diğergruplara göre anlamlı olarak düşüktü (p=0,021 vep=0,006).SonuçMPV değerleri stabil hastalarda KAH şiddeti ile ilişkilibulunmadı. T2DM hastalarında ileri yaş, erkek cinsiyet,yüksek trigliserit seviyeleri ve başlangıç glikoz seviyeleri,KAH şiddeti ile önemli ölçüde ilişkiliydi.

Objective: In our study we sought to determine the prevalence of critical left main coronary artery LMCA disease in chronic kidney disease CKD and to compare it with the prevalence in patients with normal kidney function.Material and Methods: 502 consecutive patients with stable angina pectoris who underwent coronary angiography were screened. 423 patients were included in the final analysis. Prevalence of LMCA disease was compared between patients with or without CKD. 102 patients with CKD were matched with 102 patients without CKD using propensity score matching and the prevalence of LMCA disease was compared between these groups. Results: Mean age was 61.08±10.23. Male gender and diabetes were significantly higher whereas smoking was significantly lower in patients with CKD. Mean Gensini score was higher in patients with CKD 58.66±33.77 vs. 57.62±28.69, p:0.002 . Presence of any lesion or significant stenosis in LMCA did not differ between the groups. 102 patients with CKD matched with 102 patients with normal kidney function after 1:1 propensity score analysis. Prevalence of critical LMCA disease did not differ between matched CKD and non CKD groups 21% vs 17.6% respectively, p: 0.481 .Conclusion: In patients with CKD, the prevalence of a critical LMCA lesion was not different from the patients with normal kidney function. The similarity of the prevalence persisted after propensity score matching, Amaç: Bu çalışmada kronik böbrek hastalığına KBH sahip hastalarda sol ana koroner LMCA hastalığının prevalansını ve bu prevalansın normal böbrek fonksiyonuna sahip hastalardan farklı olup olmadığını saptamayı amaçladık.Gereç ve Yöntemler: Koroner anjiyografi uygulanmış 502 ardışık stabil koroner arter hastası tarandı. 423 hasta son değerlendirmeye dahil edildi. LMCA hastalığının prevalansı KBH olan veya olmayan hasta gruplarında karşılaştırıldı. Eğilim skor analizi yöntemi ile 102 kronik böbrek yetersizliği hastası 102 normal böbrek fonksiyonuna sahip hasta ile eşleştirildi ve LMCA hastalığının sıklığı bu iki grupta karşılaştırıldı. Bulgular: Ortanca yaş 61,08±10,23 idi. KBH grubunda erkek cinsiyet ve diyabet anlamlı olarak daha fazla, sigara kullanımı ise anlamlı olarak daha azdı. Ortalama Gensini skoru KBH grubunda anlamlı olarak daha fazlaydı 58,66±33,77 vs. 57,62±28,69, p:0,002 . LMCA’da herhangi bir lezyon veya kritik lezyon varlığı iki grupta benzerdi. Birebir eğilim skor analizi yöntemi ile 102 KBH hastası 102 normal böbrek fonksiyonuna sahip hasta ile eşleştirildi. LMCA hastalığı sıklığı bu iki grupta yine benzer bulundu sırasıyla %21 vs %17,6, p:0,481 .Sonuç: KBH’ye sahip hastalarda kritik LMCA hastalık prevalansı normal böbrek fonksiyonuna sahip hastalardakinden farklı değildir. Bu benzerlik eğilim skor analizi sonrası da değişmemiştir

Sturge-Weber syndrome (SWS) is a rare neurocutaneous disease characterized with a port-wine stain and ipsilateral leptomeningeal angiomas. It may cause wide variety of neurological signs and symptoms.A 63-year-old female patient with a port-wine stain on her face was followed up in our department symptoms oftransient ischemic attack and focal epileptic seizures at 2-year intervals.The investigation of the cause of the transient ischemic attacks showed dissection of the right cavernous internalcarotid artery.To the best of our knowledge, this is the first case in the literature. In advanced age, as in our case, central nervoussystem involvement could be related to congenital abnormalities of the vascular bed. Sturge Weber sendromu (SWS) porto-şarap lekesi ve ipsilateral leptomeningeal anjiomlar ile karakterize nadirgörülen bir nörokütanöz hastalıktır. Çok çeşitli nörolojik belirtilere ve semptomlara neden olabilir.Yüzünde porto-şarap lekesi olan 63 yaşında kadın hasta bölümümüzde geçici iskemik atak ve fokal epileptik nöbetsemptomları ile iki yıl aralıklarla takip edildi. Geçici iskeminin nedeninin araştırılması sırasında sağ kavernöz internal karotis arterin diseksiyonunu gösterildi.Bildiğimiz kadarıyla, bu literatürdeki ilk olgudur. İleri yaşta bizim hastamızda olduğu gibi santral sinir sistemindevasküler yatağın konjenital anormallikleri ile ilişkili olabilir.

The Stent for Life (SFL) project's main mission is to increase the use of primary percutaneous coronary intervention (PCI) in more than 70% of all acute ST segment elevation myocardial infarction (STEMI) patients. Previous to the SFL project, thrombolysis was the dominant reperfusion strategy since a low percentage of acute STEMI patients had access to primary PCI in our country. In this study, we present the main barriers of access to primary PCI in the centers that were involved with the SFL project.Patients with acute STEMI admitted to the centers that were involved in the SFL project between 2009 and 2011 were included in the analysis.Since the inception of the SFL project, the primary PCI rate has reached over 90% in SFL pilot cities. In the last 5 years, the number of ambulances and emergency stations has increased. Since the collaboration with 112 Emergency Service, a great majority of cases were reached via the emergency medical system. The mean door-to-balloon time for the pilot cities was 54.72±43.66 minutes.After three years of the SFL project, primary PCI has emerged as the preferred reperfusion strategy for patients with STEMI in pilot cities.

The aim of this study was to determine the prevalence of heart failure (HF) in adult residents of Turkey based on echocardiography and N-terminal B type natriuretic factor.4650 randomly selected residents aged ≥ 35 years were enrolled. Height, weight, waist and hip circumference, and blood pressure measurements were taken, and a 12-lead ECG was performed. Advanced age, hypertension (HT), diabetes mellitus (DM), obesity, and chronic renal failure (CRF) were assessed. History of any heart disease, any abnormal ECG, or an NT-proBNP ≥ 120 pg/mL was accepted as echocardiography indication. Patients with systolic and/or diastolic dysfunction, or NT-proBNP ≥ 2000 pg/mL were classified as having HF if their functional capacity was NYHA ≥ Class II, and were classified as having asymptomatic left ventricular dysfunction (ASVD) if their functional capacity was NYHAClass I.The absolute and estimated prevalences were 2.9% and 6.9% for HF, and 4.8% and 7.9% for ASVD, respectively. Advanced age, male gender, history of heart disease, HT and CRF were independent predictors of HF. In patients with ejection fraction (EF)50%, HF prevalence was higher in men, while HF prevalences were higher in women when EF ≥ 50%. In global sum, HF and ALVD prevalence were similar in male and females.The prevalences of HF and ASVD are higher in Turkey when compared with western countries, despite a younger Turkish population. The established predictors of HF are valid for Turkey as well. There is a significant ASVD population in Turkey with similar characteristics and risk factors to HF. Focusing on the early detection and treatment of ASVD may prevent the progression to HF, and therefore would decrease the prevalence of HF in Turkey.

Left ventricular (LV) noncompaction is a congenital dysfunction of endomyocardial morphogenesis characterized by excessively prominent trabeculations and deep intratrabecular recesses of the myocardium. Its association with Ebstein's anomaly is very rare. A 13-year-old boy presented to the outpatient clinic for a cardiac evaluation before enrolling in a sports activity. On physical examination, there was a grade 1/6 systolic murmur at the tricuspid valve location. His electrocardiogram was normal. Transthoracic echocardiography revealed numerous large trabeculations and deep intratrabecular recesses at the apex, lateral wall, and the apical part of the interventricular septum. Color flow Doppler examination confirmed the presence of blood flow within the trabeculae. The size and ejection fraction of the LV was normal (65%). The attached margins of the septal and inferior leaflets of the tricuspid valve were apically displaced and there was mild tricuspid regurgitation. The distance between the mitral and tricuspid annuli was 20 mm. The right ventricle showed no dilatation and had normal systolic function, but the right atrium was moderately enlarged. As the patient was asymptomatic and the LV systolic function was preserved, he was scheduled for regular follow-up without medication except for low-dose aspirin (100 mg/day). After five years of follow-up, he was still asymptomatic with normal size and ejection fraction of both ventricles.

Traditional risk factors may underestimate the burden of subclinical atherosclerosis in women. Recently, multislice computed tomography (MSCT) has become widely available in detecting early coronary artery disease (CAD). We sought the prevalence of CAD in low to moderate-risk asymptomatic women by MSCT coronary artery calcium (CAC) scoring and coronary angiography.The study included 185 women (mean age 57+/-12 years) without known CAD and diabetes, with low or moderate risk for CAD based on traditional risk scoring. Coronary artery calcium scoring and coronary angiography were performed by MSCT, which included a segment-based plaque detection and characterization of calcification. The plaques were classified based on the luminal stenotic effect (50%). Patients with = or1 stenotic plaque were classified as having obstructive CAD. Angiographic findings were compared with calcium scores.Coronary artery calcium scoring and coronary angiography detected CAD in 63 (34.1%) and 100 (54.1%) women, respectively. In both groups, women were significantly older and had higher prevalences of hypertension and dyslipidemia. Coronary angiography showed CAD in 41 women (41%; 14.6% were obstructive) without CAC. These women were significantly younger than those with a positive CAC score (p0.01). Age (p0.02) and hypertension (p0.05) were found as independent predictors of CAD detected by coronary angiography.Multislice computed tomography identified a subset of low-risk women who might be at higher risk than that suggested by current risk stratification strategies. Women, especially having hypertension and dyslipidemia may be potential candidates for further risk stratification by MSCT coronary angiography.

The evaluation of left ventricular function and viability is critical in patients with suspected or documented ischemic heart disease. Recently, cardiac multislice computed tomography (MSCT) has emerged as a powerful modality for cardiac imaging. In addition to coronary artery assessment, contrast enhanced MSCT can provide reliable information about myocardial function, perfusion and viability. This review will focus on the pathophysiological mechanisms and clinical applications of contrast enhanced myocardial function and viability MSCT imaging.

Assessment and treatment of sexual dysfunction gain more importance in countries like Turkey where cardiovascular events are frequently seen in young adults. The mortality of cardiovascular events is reduced by primary percutaneous coronary angioplasty (PTCA), use of new thrombolytics in acute myocardial infarction (MI), and new drugs used in the treatment of heart failure. Because of the longer life expectancy, assessment of sexual functions and rehabilitation are getting more important in these patients. Since phosphodiesterase type 5 inhibitors (PDE 5) have been frequently utilized in the treatment of impotence, patients' and the doctors' attention have been directed towards cardiovascular risks of sexual activity. In recent years, this topic has become more important because several reports have stated the possible relationship between the use of PDE5 inhibitors and myocardial infarction. It is known, that in patients with cardiovascular diseases, sexual activity poses a low sudden death risk independent of PDE5 inhibitor use. In this review, the points that doctors should take into account while considering and treating the sexual dysfunction in patients with cardiovascular diseases are discussed.

World Health Organization and other international guide committees defined different obesity categories according to the body mass index (BMI) and waist circumferences. The purpose of our study was (i) to compare the dispersion of other coronary risk factors in patients with coronary artery disease (CAD) with different obesity categories that were defined according to the body mass index (BMI) and the waist circumference, (ii) to determine to which extent these cut-off values effect the dispersion of other coronary risk factors.The study group included 617 consecutive subjects (516 male, mean age - 57.2+/-10.8 years) who underwent their first angiography between January 2000 and May 2000 and in whom significant coronary lesions were detected. The distribution of risk factors such as, age, smoking, hypertension, diabetes mellitus, high LDL-C, low HDL-C, total cholesterol/HDL-C ratio, triglycerides, family history of premature CAD was compared between overweight and obese cases defined according to BMI values. The same risk factors were compared among the cases grouped as action level 1 and action level 2 defined by the waist circumference.In male patients; smoking was found to be higher in overweight individuals than in obese cases (71% vs. 56%) (p0.05). In female patients; the only difference was the ratio of total-C/HDL-C as being greater in obese group than overweight group (p0.05). In male and female patients there was no significant difference between obese and overweight cases regarding the number of total risk factors. According to the waist circumference, in male patients, smoking was more prevalent in action level 1 group than in action level 2 group. In female patients risk factors prevalence was similar in both groups.In patients with CAD, the amount of total risk factors doesn't differ between overweight and obese cases and between patients with action level 1 and action level 2 of the waist circumference. These findings indicate the necessity of using the same secondary prevention approaches in patients with CAD and different levels of obesity.

The aims of our study were to assess the distribution of interventional and other therapeutic procedures performed on subjects who had proven CAD by angiography in our clinic; to determine the groups of therapeutic agents prescribed at the time of discharge; and to compare these with the results of EUROASPIRE II, which examined the prophylactic drug therapy upon discharge of CAD patients in 15 European countries.Our patients comprises of 617 subjects (516 male, 101 female; mean age 57.2 +/- 10.8 years) who underwent coronary angiography for the first time in our clinic and who were found to have a 50% lesion in at least one of the coronary arteries. In all patients distribution of risk factors on admission, distribution of therapeutic procedures and the use of drug therapies at the hospital discharge were recorded.We found that, 68% of our cases were considered to be eligible for a percutaneous or surgical intervention, while 27% were assessed not as requiring such an intervention and consequently were discharged being prescribed appropriate medications. For the remaining 5% of the subjects, tests for detection of viable myocardium were advised, before selecting the proper type of management. At discharge, prescription rates for antiplatelets, beta-blockers, nitrates, statins, angiotensin-converting enzyme inhibitors (ACE-I), calcium channel blockers and anticoagulants were detected to be %99, 86%, 86%, 63%, 40%, 16%, and 2% respectively.Compared with the results of EUROASPIRE II study, these data show that, antiplatelet, beta-blocker, ACE-I and lipid-lowering treatments our subjects received upon discharge were higher, whereas anticoagulant treatment was lower than the averages of the fifteen European countries consisting the EUROASPIRE II study.